Project Summary/Abstract Every day, 120 people die from suicide, that is one person every 15 minutes. Suicide prevention treatments focus on those at highest risk and are primarily delivered as mental health treatments, and yet 70% of patients with suicide risk do not attend mental health treatment. Developing treatment for patients not served by existing suicide prevention programs will improve access to care and is necessary to stop suicide. Patients with chronic pain in the US (100 million) have 2.6-times greater risk of suicide and those on long-term opioid treatment are at even greater risk. Unfortunately, they often do not receive mental health treatment and thus do not receive suicide prevention interventions. They do receive frequent healthcare for their pain providing an unmet opportunity to integrate suicide prevention into their treatment for pain. This study aims to test the efficacy of Problem-Solving Treatment (PST) for suicidal ideation and chronic pain as a therapy that can be delivered in non-mental health settings. Our hypothesis is that PST for suicidal ideation and chronic pain will reduce suicidal ideation by reducing problem-solving deficits and feelings of burdensomeness and not belonging. The goal of this study is to test the efficacy of remote-delivered PST for suicide and chronic pain and elucidate the active components of treatment. Our specific aims are: (Aim 1) remote-delivered PST reduces (H1) suicidal ideation (H2) problem-solving deficits (H3) pain-related disability, (H4) feelings of burdensomeness and (H5) feelings of not belonging as compared to enhanced health education for patients with chronic pain and suicidal ideation immediately after treatment and 6 months after treatment. (Aim 2) Determine mechanisms of change by examining whether reductions in problem-solving deficits, feelings of burdensomeness, and feelings of not belonging mediate the relationship between PST and reductions in suicidal ideation among patients with suicidal ideation and chronic pain. (Exploratory Aim 3) Explore if remote delivered PST is efficacious for patients with chronic pain and moderate suicide risk who are prescribed long- term opioids and not prescribed long-term opioids. Findings from this study will help elucidate the mechanisms by which chronic pain contributes to suicidal ideation and importantly, identify the active mediating targets for suicide prevention treatments.